Sunday, August 14, 2016

Multigenerational Households on the Rise

I was reading a recent report from Pew Research Center's FactTank about the rise in multigenerational households. The data might surprise you. A record 60.6 million Americans live in multigenerational households notes that almost 20% of folks in the U.S. live in a multigenerational household ("defined as a household that includes two or more adult generations, or one that includes grandparents and grandchildren....")  The article reminds us of the downturn in multigenerational households back in the 1950s through the 1980s, but these households have been on the rebound since then.  The increase is across the spectrum of ages, ethnicity, etc. As far as elders, "more than a fifth live with multiple generations under one roof, including Americans ages 55 to 64 (23% in 2014) and 65 and older (21%). The rise in multigenerational living among these older Americans is one reason why fewer now live alone than did in 1990."  Not unsurprisingly, the most typical household is parents and adult children.  However, grandparent-parent-adult children households are growing as well. "Three-generation households – for example, grandparents, parents and grandchildren – housed 26.9 million people in 2014."

August 14, 2016 in Consumer Information, Current Affairs, Housing | Permalink | Comments (0)

Thursday, August 11, 2016

Are "Granny Flats" The New NIMBY?

Bear with me-this is going to take a bit for me to connect the dots to my point. We have posted on several occasions about the need for caregivers as the Boomers continue their aging trek. We've also blogged about the shortage of caregivers and the impact caregiving has on family members.  With me so far? So, it would seem logical that we want to make it as easy as possible for caregivers to provide care. In many instances for the family caregivers do this, the family lives together, whether the parent moves in with the adult kids or vice versa. In other instances, the home may be remodeled to make it appropriate for multi-generational families.  In others, the caregivers add to their property with an auxiliary dwelling unit or ADU (popularly known as a  granny flat), a medical-cottage, or even converts their garage into a "mother-in-law" apartment.  

Still with me? So, when remodeling, we may need a permit. When we are adding a building, renovating or bringing in an ADU or med-cottage, we may run afoul of zoning ordinances, when zoning is for single families. Hopefully local governments, understanding the need for caregiving, would be willing to grant variances for this, although there are cases where the contrary has occurred.

So this is all a lead up to a recent story in the Washington Post. The Next big Fight Over Housing Could Happen, Literally, In Your Back Yard opens with the story of a couple who had built their home in their daughter's back yard. Here's what happened:

They were just finishing the place when a lawsuit earlier this year against the city of Los Angeles brought permits for homes like theirs — second units on single-family lots — to a halt. As a result, city officials who gave them permission to build now haven’t given them a certificate of occupancy, and the utility won’t connect them to the power grid.

Second homes, often called “granny flats,” have become a new front in the conflict that pits the need for more housing in the country’s most expensive cities against the wishes of neighbors who want to preserve their communities. The same battles flare over large developments that might loom over single-family neighborhoods. But even this modest idea for new housing — let homeowners build it in their own back yards — has run into not-in-my-back-yard resistance.

And the difficulty of implementing even such a small-scale solution shows why it will be hard to make room in crowded cities for the middle- and working-class households who increasingly struggle to afford to live there.

Not only do these "second homes" help caregivers live in proximity to the elder, these second homes could also alleviate housing shortages according to the article.  So what's the objection?  "Many neighbors, though, protest that a glut of back yard building would spoil the character of neighborhoods designed around the American ideal of one family on one lot surrounded by verdant lawn. They fear that more residents will mean less parking. And they question whether small homes, particularly in wealthier neighborhoods with the most room to build them, would really constitute affordable housing."

Do these concerns really apply if the purpose is to provide caregiving to a family member? I realize that it's difficult to separate out second housing units designed as rental income from second houses designed for caregiving. The article notes that several cities are considering revisions to their zoning ordinances, primarily to address the need for more affordable housing.  But let's not forget about the caregivers and their parents. Let's make it as convenient as possible for them to provide care, even if it is just to allow the temporary installation of ADUs or medical cottages.

 

August 11, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing | Permalink | Comments (0)

Fighting Ageism....and Losing

Serious bummer. According to an article in the Washington Post, the fight against ageism is a losing battle. Baby Boomers are Taking on Ageism---and Losing starts with the challenges that boomers face in the workplace: continuing in their jobs supervised by younger folks, or returning to the work force. This quote gave me pause: "At a time when conditions have vastly improved for women, gay people, disabled people and minorities in the workplace, prejudice against older workers remains among the most acceptable and pervasive “isms.” And it’s not clear that the next generations — ascendant Gen Xers and millennials — will be treated any better."   Thus, we all should be concerned about ageism.

Ageism, not a new phenomenon, is explored from several angles in this article. 

That bias [for young] is so common we frequently don’t recognize it. Todd Nelson, a psychology professor at California State University at Stanislaus, has singled out birthday cards for portraying advancing age as something to be ashamed of, with a tone that would never be used with race or religion. (“ ‘Ha-ha-ha, too bad you’re Jewish’ ... wouldn’t go over so well,” he noted.)

Internet memes like the “Scumbag Baby Boomer” and “Old Economy Steve,” which lambast boomers for transgressions from failing to adopt technology to causing the wars and recessions that millennials have weathered, channel resentment against an entire category of people in ways that might not be tolerated if they were members of another protected class.

As a big believer in life-long learning, I was concerned that there are those who have mindsets regarding the talents of those who are older.  "In a 2015 survey by the Harris Poll, for example, 65 percent of boomers rated themselves as being the “best problem-solvers/troubleshooters,” and only 5 percent of millennials agreed. Fifty-four percent of millennials thought boomers were the “biggest roadblocks.” Sometimes these perceptions come straight from the top: Facebook founder Mark Zuckerberg once said 'young people are just smarter.'"

After looking at the laws that protect against age discrimination, the article examines some of the causes of ageism and efforts to thwart it.  This article could be the foundation for a great discussion during the first week of your class. Check it out!

 

August 11, 2016 in Consumer Information, Current Affairs, Discrimination | Permalink | Comments (0)

Wednesday, August 10, 2016

Integrating Criminal Justice Standards with Professional Conduct Rules for Attorneys Representing Clients with a Mental Health Disability

During the 2016 Annual Meeting of the American Bar Association that concluded on August 9 in San Francisco, the ABA adopted "the black letter of the ABA Standards for Criminal Justice: Criminal Justice Mental Health Standards, chapter seven of the ABA Standards for Criminal Justice, dated August 2016, to supplant the Third Edition (August 1984) of the ABA Criminal Justice Mental Health Standards." 

Here is a link to the Full Resolution

Here is a link to further details and a report: Proposed resolution and report

Significantly, the revised ABA standard expressly requires criminal defense lawyers to consider the implications of ABA Model Rule of Professional Conduct 1.14 (for representation of a client with diminished capacity), in determining whether, when and how much information can be shared about the client's disability with family members or others during the course of representation.  My initial reaction is this integration of the two concepts may actually broaden the defense attorney's authority to share information, rather than restrict it.  

Any thoughts among our readers? My special thanks to my colleague Professor Laurel Terry at Dickinson Law, guru of all matters related to professional conduct rules for attorneys and judges, for sharing the revised standard. 

August 10, 2016 in Cognitive Impairment, Crimes, Current Affairs, Dementia/Alzheimer’s, Ethical Issues | Permalink | Comments (0)

Accessible National Parks: A Goal by 2020?

With summer winding down, and the fall semester bearing down on us, hopefully everyone had a fabulous summer. For many of us, summer vacation included a trip to a national park.  I was lucky enough to spend some time in the Rocky Mountain National Park. One day I was walking along an accessible trail, and noticed 4 folks using wheelchairs within the first 100 feet of the trail. This particular trail also offers an accessible campsite. That got me thinking about how many trails in national parks are accessible. That led me to an internet search  (yay Google) which led me to this report, All In! Accessibility in the National Park Service 2015-2020.  The report explains the creation of a task force on accessibility which developed a "strategic plan with specific strategies on how to make parks and programs accessible to a broader range of audiences. These strategies are focused on actions needed to build momentum, augment capacity, and accelerate real improvements over the next five years (2015–2020)." 

The parks are definitely not as accessible as they could be-or should be for that matter.  "[T]he National Park Service is underserving people with varying abilities and their traveling partners. Without accessible parks, the National Park Service loses an opportunity to reach the widest possible audience and share a spectrum of experiences. This lost opportunity is a direct failure to carry out our mission. Both long- and short-term solutions are needed to build momentum and advance the program."  The report sets out 3 goals for the NPS:

  1. "Create a welcoming environment by increasing the ability of the National Park Service to serve visitors and staff with disabilities."
  2.  "Ensure that new facilities and programs are inclusive and accessible to people with disabilities."

  3.  "Upgrade existing facilities, programs, and services to be accessible to people with disabilities."

 

 

 

August 10, 2016 in Consumer Information, Current Affairs, Other, Travel | Permalink | Comments (0)

Tuesday, August 9, 2016

Does Use of "Alzheimer's" as a Catch-all Label Cause Confusion?

Recently, a friend who is a neuropsychologist reminded me that the medical profession is moving away from using either dementia or Alzheimer's as a broad category label.  For example, in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, commonly referred to as the DSM followed by a number that indicates the edition, the current edition (DSM-5) replaced the label "Dementia, Delirium, Amnestic and Other Cognitive Disorders" with "Neurocognitive Disorders" or NCDs.  As we talked, it occurred to me that this is an important change, and one that legal professionals should also embrace more strongly.  While short-hand labels can be useful, I think that using dementia alone as a label can invoke a stereotype that has the potential to confuse the public, while also unnecessarily frightening the client or client's family.  It can invoke an image of nursing homes or institutionalization, rather than what may be more appropriate, such as supported or guided decision-making or use of alternative decision-makers or agents, especially in early stages of the disorders.

As the DSM-5 further explains:

Although cognitive deficits are present in many if not all mental disorders (e.g., schizophrenia, bipolar disorders), only disorders whose core features are cognitive are included in the NCD category.  The NCDs are those in which impaired cognition has not been present since birth or very early life, and thus presents a decline from a previously attained level of functioning.

 

The NCDs are unique among DSM-5 categories in that these are syndromes for which the underlying pathology, and frequently the etiology as well, can potentially be determined.  The various underlying disease entities have all been the subject of extensive research, clinical experience, and expert consensus on diagnostic criteria.... Dementia is subsumed under the newly named entity major neurocognitive disorder, although  the term dementia is not precluded from use in the etiological subtypes in which the term is standard. Furthermore, DSM-5 recognizes a less severe level of cognitive impairment, mild neurocognitive disorder, which can also be a focus of care....

Indeed, greater appreciation for mild neurocognitive disorders is important in legal circles, as the changes may often be subtle or difficult to recognize, but still very important when talking about legal capacity or decision-making under the law.  

August 9, 2016 in Cognitive Impairment, Dementia/Alzheimer’s, Estates and Trusts, Ethical Issues, Science | Permalink | Comments (0)

Aging with Special Needs

Disability Scoop ran an article recently focusing on aging issues faced by those with special needs. Aging Poses New Challenges For Those With Special Needs explains the issues that will occur as individuals with special needs age, and need different or additional services.  "In 1983, the average life expectancy for a person with Down syndrome was 25. Today, it’s 65 to 70, fueled largely by the mastery of a surgical procedure that corrects a heart defect present in 1 out of 2 people with Down syndrome ...."  Of course, there are challenges to be overcome, including increasing services and bringing health care providers up to speed. "As the first generation of individuals with disabilities reaches ages not seen before, the medical community is still catching up. Most skilled nursing facilities are still made up of residents without disabilities, so people with disabilities may be better suited to an environment where caregivers are accustomed to taking their special needs into account." 

The article highlights the need to be forward-thinking and planning ahead.  Not everyone ages the same way at the same speed.  The article focuses on how a person with Downs syndrome might experience aging issues. The "interest in caring for people with disabilities who are aging has been of such concern that the [National Down Syndrome Society] compiled an “Aging and Down Syndrome” guide in 2013. Since then, the guide has been requested tens of thousands of times, in both English and Spanish ...."

August 9, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care | Permalink | Comments (2)

Monday, August 8, 2016

Which "Breakthrough" Will Prove to be the Real Miracle Needed to Prevent or Cure Alzheimer's?

I've been writing for the Elder Law Prof Blog for almost exactly three years, and it has been a wonderful way to keep up with the vast array of topics that affect "law and aging," Blogging has broadened my horizons, especially with respect to medicine and science.  At first I would get excited about each new announcement of a potential drug or treatment that "might" cure Alzheimer's.

Over time, you learn to be more, shall we say, judicious in reporting on the report of cures.

Australian researchers announced last year that they "have come up with a non-invasive ultrasound technology that clears the brain of neurotoxic amyloid plaques - structures that are responsible for memory loss and a decline in cognitive function in Alzheimer’s patients." Their preliminary work is with mice:

Publishing in Science Translational Medicine, the team describes the technique as using a particular type of ultrasound called a focused therapeutic ultrasound, which non-invasively beams sound waves into the brain tissue. By oscillating super-fast, these sound waves are able to gently open up the blood-brain barrier, which is a layer that protects the brain against bacteria, and stimulate the brain’s microglial cells to activate. Microglila cells are basically waste-removal cells, so they’re able to clear out the toxic beta-amyloid clumps that are responsible for the worst symptoms of Alzheimer’s.

 

The team reports fully restoring the memory function of 75 percent of the mice they tested it on, with zero damage to the surrounding brain tissue. They found that the treated mice displayed improved performance in three memory tasks - a maze, a test to get them to recognise new objects, and one to get them to remember the places they should avoid.

 

"We’re extremely excited by this innovation of treating Alzheimer’s without using drug therapeutics," one of the team, Jürgen Götz, said in a press release. "The word ‘breakthrough’ is often misused, but in this case I think this really does fundamentally change our understanding of how to treat this disease, and I foresee a great future for this approach."

What has happened since the first news "alert," published in March 2015?   Perhaps one of our readers knows the latest on this particular approach, and can bring more light to bear on this breakthrough.  For more, read,  Science Alert: "New Alzheimer's Treatment Fully Restores Memory Function."  Special  thanks to GW Law Professor Naomi Cahn for bringing this item  to our attention.

August 8, 2016 in Cognitive Impairment, Dementia/Alzheimer’s, Ethical Issues, Science | Permalink | Comments (0)

Sunday, August 7, 2016

Global Retirement Security Report: We're Number .... 14!

Investment News published a story about retirement security across the globe, and reports that the U.S. ranks #14.  U.S. comes in 14th in global ranking of retirement security reports on Natixis Global Asset Management's annual ranking. The article explains that Norway, Switzerland and Iceland came in 1, 2 and 3 respectively, while the U.S. finished at 14 out of 43.  According to the article, we did better in some categories, even breaking the top 10, for example, "No. 7, in the health care part of the index." But bummer, we were "No. 30 for life expectancy." But even more of a bummer, "[o]ne area in which the U.S. had an abysmal ranking was in its high level of income inequality, which helped drive it down to No. 37 of the 43 countries. The U.S. and Singapore share the dubious distinction of being the only countries in the top five for income per capita and in the bottom 10 for their large gaps in income equality." According to the article "Norway joins a number of top 10 countries in having a compulsory workplace savings program. It requires employers to fund private retirement accounts with 2% of a worker's earnings annually. That pales next to Australia, No. 6, where employers must kick in at least 9.5%. "

The full Natixis report is available here.

 

August 7, 2016 in Consumer Information, Current Affairs, International, Retirement | Permalink | Comments (0)

Friday, August 5, 2016

And then there is the "Alligator Problem"....

Earlier in the week, I shared the feature news story on "avoidable deaths" in Pennsylvania long-term care, often shown to be linked to inadequate staffing (whether in numbers or training, or both).  The article began with a fall of a man while apparently unattended, and also identified residents "choking" on food as another documented risk associated with staffing and supervision.

But other senior care communities in the country may have their own unique complications.  South Carolina has reported its first apparent "alligator attack," sadly connected to the death of a 90-year-old woman, who was earlier reported missing from her assisted living community.  For more, read the Post-Courier report from  July 29, 2016.   

 

August 5, 2016 in Dementia/Alzheimer’s, Ethical Issues, Health Care/Long Term Care, Housing | Permalink | Comments (1)

Thursday, August 4, 2016

Housing Resource for Elders

Legg Mason released a 142 page document on elder housing,  Aging & Its Financial Implications: Planning for Housing. The report was created "in collaboration with The Center for Innovative Care in Aging at the Johns Hopkins University School of Nursing, to bring [the reader] perspective, research and practical insights to assist [the reader] with the challenges of aging.  The document includes a discussion guide for determining one's housing needs, information about different types of housing, case studies, a check list, charts, graphs and data, resources and more. Why is thinking about housing important? Because, according to the report, "America is aging and everyone is affected by longer life expectancy. As advanced age approaches, people often need to shift the way they live and/or where they live to accommodate age-related discomforts and reduced capabilities. There are a number of trends that impact decisions related to housing during the years of retirement."

BTW, the company has more info on aging on its website, available here. I particularly liked the headline on the website about the housing document" "'NOW WHAT?' IS NOT A STRATEGY"

 

 

 

 

August 4, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing | Permalink | Comments (1)

New Book: A New Deal for Old Age

Yale Law Professor Anne Alstott has a new book out, published by Harvard Press. A New Deal for Old Aget looks to be an important read.  From the introduction (available in full for free download on SSRN), 

America’s system for managing retirement is badly out of step with these realities. Enacted in the 1930s, Social Security reflects a time when most workers were men who held steady jobs until retirement at 65 and remained married for life. The program promised a dignified old age for rich and poor alike, but today that egalitarian promise is failing. This introductory chapter to A NEW DEAL FOR OLD AGE outlines a progressive program that would permit all Americans to retire between 62 and 76 – but would offer more generous benefits for early retirement for workers with low wages and physically demanding jobs. The chapter also sketches the case for a more equitable version of the outdated spousal benefit and a new phased-retirement option to permit workers to transition out of the workforce gradually.

Our thanks to George Washington Law Professor Naomi Cahn, a prolific scholar in her own right, for this tip.  

August 4, 2016 | Permalink

Wednesday, August 3, 2016

Prisoners with Disabilities

We have blogged on several occasions about the graying of prisons. What about individuals in prisons who have, or develop disabilities? The Center for American Progress issued a report, Disabled Behind Bars: The Mass Incarceration of People with Disabilities in America's Jails & Prisons.   Here is an excerpt from the introduction

People with disabilities are thus dramatically overrepresented in the nation’s prisons and jails today. According to the Bureau of Justice Statistics, people behind bars in state and federal prisons are nearly three times as likely to report having a disability as the nonincarcerated population, those in jails are more than four times as likely. Cognitive disabilities—such as Down syndrome, autism, dementia, intellectual disabilities, and learning disorders—are among the most commonly reported: Prison inmates are four times as likely and jail inmates more than six times as likely to report a cognitive disability than the general population. People with mental health conditions comprise a large proportion of those behind bars, as well. The Bureau of Justice Statistics reports that fully 1 in 5 prison inmates have a serious mental illness. (Citations omitted).

The full report is available here.

 

August 3, 2016 in Consumer Information, Crimes, Current Affairs | Permalink | Comments (0)

Lifelong Housing

AARP's Livable Communities project published a recent article, How to Encourage More 'Lifelong' Housing.  The article explains a project that came out of southern Oregon, what is known as "The Lifelong Housing Certification Project."  The article explains this project:

A voluntary evaluation program, the Lifelong Housing Certification Project provides a way to assess the "age-friendliness" and accessibility of both newly constructed and existing homes..  the program includes a comprehensive checklist of features and defines levels of certification based on various universal design standards.

The certification is appropriate for all homes — rental apartments, new construction or existing houses — and is intended to help consumers and industry professionals choose the desired level of accessibility in buying, selling or modifying homes. The Lifelong Housing Certification Project helps the marketplace respond to a growing demand for accessible and adaptable homes that promote aging in place safely and independently. At the same time, the certification makes it easier for individuals of all ages to find homes that are suitable for lifelong living and promote the social and economic value of lifelong livability.   

The article explains the benefits and value, and the process for homeowners who wish to have their home "certified" (the owner receives a certificate, which can be provided, along with a "checklist to potential buyers. The certification may also be indicated on the local Multiple Listing Service in order to flag the home as being a "lifelong home" and alert potential buyers to ask the home seller or real estate agent for information regarding the home’s certification level.")  There are links at the end of the story for those readers who want to learn more.

August 3, 2016 in Consumer Information, Current Affairs, Housing | Permalink | Comments (0)

Tackling the Issue of "Avoidable Deaths" in Long-term Care Settings

Pennsylvania attorney Douglas Roeder, who often served as a visiting attorney for my former Elder Protection Clinic, shared with us a detailed Penn Live news article on what the investigative team of writers term "avoidable deaths" in nursing homes and similar care settings.  The article begins vividly, with an example from Doylestown in southeastern Pennsylvania:

Claudia Whittaker arrived to find her 92-year-old father still at the bottom of the nursing home's front steps. He was covered by a tarp and surrounded by police tape, but the sight of one of his slim ankles erased any hope it wasn't him.  DeWitt Whittaker, a former World War II flight engineer, had dementia and was known to wander. As a result, his care plan required him to be belted into his wheelchair and watched at all times. Early on Sept. 16, 2015, Whittaker somehow got outside the Golden Living home in Doylestown and rolled down the steps to his death.

 

"It wasn't the steps that killed him. But the inattention of staff and their failure to keep him safe," his daughter said.

The article is especially critical of recent data coming from for-profit nursing homes in Pennsylvania, pointing to inadequate staffing as a key factor:

In general, according to PennLive's analysis, Pennsylvania's lowest-rated nursing homes are for-profit facilities. Half of the state's 371 for-profit homes have a one-star or two-star rating – twice the rate of its 299 non-profit nursing homes.  The reason for that discrepancy, experts say, isn't complicated: Studies have found that for-profit nursing homes are more likely to cut corners on staffing to maximize profit.

Spokespeople from both the for-profit and nonprofit segments of  the industry are quoted in the article and they push back against the investigators' conclusions.  

I have to say from my own family experience that while adequate staffing in care settings is extraordinarily important, older residents, even with advanced dementia, often have very strong opinions about what they prefer.   My father is in a no restraint dementia-care setting, with a small cottage ("greenhouse") concept and lots of programming and behavioral interventions employed in order to avoid even the mildest of restraints. It was a deliberate choice by the family and my dad walks a lot around the campus and has his favorite benches in sunny spots. 

The trade-off for "no restraints" can be higher risk.  Residents, including my father, are sometimes stunningly adept at escape from carefully designed "safety"plans, such as those necessary in the summer heat of Arizona. Family members often remain essential members of the care team.  For example, this summer I plan my daily visits at the very hottest part of the day, in order to help try to lure my father, a late-in-life sunshine worshiper, back into the cool.  I watch the staff members exhaust themselves intervening with other ambulatory and wheelchair residents who are constantly on the move.

None of this "care stuff" is easy, but certainly the Penn Live article paints a strong picture for why better staffing, better financial resources, and more reality-based plans are necessary.  For more, read "Failing the Frail." Our thanks to Doug for sharing this good article. 

August 3, 2016 in Cognitive Impairment, Consumer Information, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Housing, Medicaid, Medicare, Property Management | Permalink | Comments (0)

Tuesday, August 2, 2016

HHS Guidance for Care in the Most Integrated Setting

Health and Human Services (HHS) Office for Civil Rights issued guidance in late May, 2016 for long term care facilities. The guidance, Guidance & Resources for Long Term Care Facilities: Using the Minimum Data Set to Facilitate Opportunities to Live in the Most Integrated Setting " is on using the minimum data set (MDS) so "residents receive services in the most integrated setting appropriate to their needs."

There are 3 recommendation sections  of the guidance (actually there are 4, but the 4th deals with further resources).  Why did OCR issue this guidance?

OCR has found that many long term care facilities are misinterpreting the requirements of Section Q of the MDS. This misinterpretation can prevent residents from learning about opportunities to transition from the facility into the most integrated setting. We are therefore providing a series of recommendations for steps that facilities can take to ensure Section Q of the MDS is properly used to facilitate the state’s compliance with Section 504 and to avoid discrimination.

The recommendations include a discussion of the importance of knowing about local resources and community based services, ensuring compliance with applicable civil rights laws ("[b]ecause Section Q is designed to assist residents in returning to the community or another more integrated setting appropriate to their needs, proper administration of Section Q of the MDS can further a state’s compliance with civil rights laws.") and the importance of maintaining up-to-date policies and procedures, and training employees.

 

 
 
 

August 2, 2016 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare | Permalink | Comments (0)

Tough Talk about Health Care Fraud

McKnight's News is a publication for insiders in the long-term care industry, reaching professionals who operate nursing homes, extended care sites, CCRCs and more. John O'Connor, who has been with McKnight's for more than 20 years, recently published  a candid editorial about factors affecting health care fraud in the industry.  He writes:

[G]iven how easy it is to cheat these days, we probably shouldn't be terribly surprised that so many operators give in to temptation. That's especially the case when it comes to invoice preparations. 

 

Let's be honest: How hard is it to put a resident in a higher RUGs category than is probably accurate? Or to bill for therapy services that were not actually delivered? Or to have therapists working overtime doing services that never should have occurred in the first place? And that, my friends, is just the tip of the proverbial iceberg.

 

Throw in stiff competition, incentives that reward upcoding, a dearth of interested investigators and good old-fashioned human greed, and what we have here is a breeding ground for creative accounting.

For more, read "It's Time for 'The Talk' About Healthcare Fraud."  

August 2, 2016 in Current Affairs, Ethical Issues, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare | Permalink | Comments (0)

Monday, August 1, 2016

New Scholarship: Can Adults, including Older Adults, Give Advance Consent to Sexual Relations?

As some readers may recall, last year we reported on the emotionally fraught criminal trial in Iowa for a former state legislator, who was ultimately acquitted of sexual assault of his wife.  The allegations arose in the context of alleged sexual relations with his wife after she was admitted to a nursing home.  

Assistant Professor of Law Alexander A. Boni-Saenz, from Chicago Kent College of Law, has drawn upon this case and others to further explore his proposals for "advance directives" whereby adults could specify their decisions in advance of incapacity.  Alex's latest article, Sexual Advance Directives, forthcoming in the Alabama Law Review, is available on SSRN here.   From the abstract:

Can one consent to sex in advance? Scholars have neglected the temporal dimension of sexual consent, and this theoretical gap has significant practical implications. With the aging of the population, more and more people will be living for extended periods of time with cognitive impairments that deprive them of the legal capacity to consent to sex. However, they may still manifest sexual desire, so consenting prospectively to sex in this context serves several purposes. These include protecting long-term sexual partners from prosecution by the state, ensuring sexually fulfilled lives for their future disabled selves, or preserving important sexual identities or relationships. The law currently provides a device for prospective decision-making in the face of incapacity: the advance directive.

 

The central claim of this article is that the law should recognize sexual advance directives. In other words, people facing both chronic conditions that threaten their legal capacity to make decisions and institutional care that threatens sexual self-determination should be able to consent prospectively to sex or empower an agent to make decisions about sex on their behalf. To justify this claim, the Article introduces a novel theory of sexual consent—the consensus of consents—that diffuses the longstanding philosophical debates over whether advance directives should be legally enforceable. With this normative foundation, the Article then draws on insights from criminal law, fiduciary law, and the law of wills to fashion a workable regime of sexual advance directives that adequately protects individuals from the risk of sexual abuse. 

Alex is a thoughtful writer on challenging topics, often looking at the intersection of health care, estate law and elder law planning.

August 1, 2016 in Advance Directives/End-of-Life, Cognitive Impairment, Crimes, Dementia/Alzheimer’s, Estates and Trusts, Ethical Issues | Permalink | Comments (1)

Sunday, July 31, 2016

Explaining Special Needs Trusts

Raymond James wealth management group has published a 5 page document for clients that explains special needs trusts.  Special Needs Trusts Providing for a Family Member with a Disability or Special Needs provides an overview of SNTs, the types of SNTs, how they work, and how they are managed. (I know that there are many such documents out there, and many are designed for the organization's clients.) I thought the graphics in this one were useful, so I'm passing on the info to you, for what it's worth.  (Full disclosure, one of our alums is the Chief Trust Officer for Raymond James). 

If you have run across any similar documents that you think are useful, let us know. After all, it's August, which means it is time for us to begin thinking about the beginning of the fall semester...and reading assignments for students.

 

July 31, 2016 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care | Permalink | Comments (0)

Friday, July 29, 2016

Partnerships for an Educated Work Force to Support Senior Living

My good friend (and former New York Administrative Law Judge) Karen Miller recently had successful hip replacement surgery and I was happily amused when I realized she wasn't home two hours before she was already corresponding with me about the latest hot topics in "aging."  Karen is a great example of an "active mind!"

Her latest communications focused on a topic I'd also been discussing recently with Stephen Maag, Esq., Director of Residential Communities for LeadingAge.   Steve had mentioned that one of the challenges facing senior living across the board was attracting an appropriately trained and stable work force.  

Karen pointed out to me that her CCRC (or, to use the latest label, Life Plan Community) in Florida was looking into partnering with a local high school and community college to provide financial support to students as well as site-based training in senior living.  For example, Certified Nursing Assistants or CNAs may often think of hospitals or "nursing homes" as primary employers, but Karen pointed out that active senior living communities may offer far more attractive opportunities for employment, while still needing workers, such as CNAs, with specialized skills . 

Karen pointed me to an article about a similar collaborative program in Maryland already under operation:

Thanks to a partnership with Ingleside at King Farm, a not-for-profit continuing care retirement community (CCRC) in Rockville, Maryland, students get first-hand experience in senior living and caregiving while residents enjoy participating in their education. And the partnership proves mutually beneficial, providing the CCRC access to a well-trained labor supply.

 

“Having a program like this exposes the younger generation to the health care field,” Adaeze Ikeotuonye, Ingleside at King Farm’s health care administrator, tells SHN. “Not many people in high school are necessarily thinking of working in the senior living industry, but bringing them in at such a young age and letting them see what the career possibilities are—that mixes up the dynamics.”

 For more about creative partnerships to deal with caregiver shortages, read Senior Housing News' "CCRC Helps Forge High School-to-Senior Living Career Path."  

Thanks to Karen for this link and best wishes for continued rapid recovery.

July 29, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Retirement | Permalink